agenda item 3e-2 palm beach county board of county ...apr 05, 2016 · section ii continued:...
TRANSCRIPT
Agenda Item #: 3E-2 PALM BEACH COUNTY
BOARD OF COUNTY COMMISSIONERS BOARD APPOINTMENT SUMMARY
------------------------------------------------------------------------------------------------------------------------------------------------Meeting Date: Department: Advisory Board:
April 5, 2016 Community Services Palm Beach County HIV CARE Council
------------------------------------------------------------------------------------------------------------------------------------------------I. EXECUTIVE BRIEF
Motion and Title: Staff recommends motion to approve: reappointments to the Palm Beach County HIV Comprehensive AIDS Resources Emergency (CARE) Council for three (3) year terms effective April 16, 2016.
Seat No. Rea~~ointment Seat Requirement Term Ending 2 Vicki A. Krusel CBOs Serving Affected Populations 04/15/2019
(f/k/a Tucci) 11 Mary Piper Kannel PBC Health Department 04/15/2019
Representative 12 Mary Jane Reynolds Affected Community Representative 04/15/2019
14 Glenn J. Krabec Affected Community Representative 04/15/2019
16 Cecil Smith Affected Community Representative 04/15/2019
19 Shirley Ann Samples Affected Community Representative 04/15/2019
31 Jeannette Tomici Part D/Org. Serving Children, Youth, 04/15/2019 Families of HIV
Summary: The total membership shall be no more than 33 members, per Resolution No. 2011-1560. The HIV CARE Council nominations process is an open process with publicized criteria and legislatively defined conflict of interest standards. The seven reappointments successfully completed the HIV CARE Council nominations process, and the HIV CARE Council has recommended their reappointments. Ms. Kannel has disclosed that she is employed by Florida Department of Health, that contracts with the County for services. Ms. Krusel has disclosed that she is employed by Legal Aid Society of Palm Beach County, that contracts with the County for services. Ms. Tomici has disclosed that she is employed by Children's Case Management Organization, Inc. d/b/a Families First of Palm Beach County, that contracts with the County for services. The HIV CARE Council provides no regulation, oversight, management, or policysetting recommendations regarding contracts. Disclosure of these contractual relationships is being provided in accordance with the provisions of Sect. 2-443, of the Palm Beach County Code of Ethics. Including the current request for appointment, the board makeup will consist of four (4) Black females, three (3) Black males, four (4) White males, three (3) White females, two · (2) Hispanic females, one (1) Hispanic male and one (1) Caribbean female. (Ryan White) Countywide (HH)
Background and Justification: In accordance with the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (P.L.101-381), Palm Beach County was designated an eligible metropolitan area disproportionally affected by the HIV epidemic and having a demand for services exceeding the capacity of local resources to meet that demand. The federal government, through the Department of Health and Human Services has made funds available to Palm Beach County to meet such demand. In order to access these funds, it is legally mandated by Title I (Part A) of the Ryan White Care Act that Palm Beach County designate a Title I (Part A) HIV Services Planning Council. To that end, the Board established the Palm Beach County HIV CARE Council, per Resolution No. R-2011-1560, dated October 18, 2011. The Ryan White CARE Act Amendments of 1996 mandate a nomination process for appointments to Title I (Part A) Planning Councils. As vacancies occur on the CARE Council, replacements are selected in accordance with the HIV CARE Council nominations process that was adopted by the CARE Council and approved by the Board on June 27, 2011.
Attachments: 1. Board/Committee Applications 2. Proposed Inventory of Seats List 3. HIV CARE Council Nominations Policy No. 10 4. CARE Council Attendance
==================:;==/=;:;=~:=~::~~7'==================t7========= Recommended By: < ~/>f'_./ .: c_/.·L~:::_.____ .s //l-·//,A
De~rtment Direct r t>afe Legal Sufficiency:
Date
II. REVIEW COMMENTS
A. Other Department Review:
Department Director
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I IDepartment}: (Please Print)
Board Name: _P_alm __ B_ea_c_h_C_o_un__.ty"--HIV __ C_A_RE __ C_o_u_n_c1_·1__________ Advisory [ x ] Not Advisory [
[ x ] At Large Appointment or , L { l[ ] District Appointment /District #: __ _ ,- f(o l(q Lf/ 15° f 19·
Tenn of Appointment: 3 Years. From: April 2016 To: _A~pr_il_2_0_1_9 ______ _
Seat Requirement: _C_B_O_s_s_e_rv_in-'g""'--af_:6_ec_t_ed__._po_.p._u_la_t_io_n_s/_A_ID_S_S_e_r_vi_c_e _O_r,.,,_ga_n_iz_a_t1_· o_n__ Seat #: 2
[ x ] *Reappointment or [ ] New Appointment ·
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _none __ _
Section II (Applicant): (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: Krusel Last
Occupation/ Affiliation:
Business Name:
Business Address:
City & State
Residence Address:
Vicki First
Attome
Owner [ ] Employee [ x ]
Legal Aid Society of Palm Beach County
423 Fem Street Ste 200
_W_e_s_t_P_alm_B_ea_c_h-'-, _F_L _________ Zip Code:
2383 SW 14th Ave
_B_oyn"---t_on_B_e_ac_h-"-,_F_L __________ Zip Code:
~ (f/k/a/ Tucci) Middle
Officer [ ]
33401
33426 City & State
Home Phone: ( } Business Phone: --'-----''------------- (561) 655-8944 Ext.252
Cell Phone: _(.,__-<--) _________ Fax: ( )
Email Address: [email protected]
Mailing Address Preference: [ x ] Business [ ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __ If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ ] Male [ ] Hispanic-American
[x ] Female [ ] Asian-American [ ] African-American [ x] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: (R#XX-XX/PO XX)
NONE
Department/Division
Parks & Recreation
Description of Services
General Maintenance
G,(IJMU~r}y SeH1c:e P(ID/\ dk CliMrnr1~,+,1SaJ1te ~I\ l,j11-\:-e.
D
(Atta'ch Additional Sheet(s);7f necessary) OR
NOT APPLICABLE/ D (Governmental Entity)
10/01/00-09/30/2100
'l } I W{0 3(1 ./.S ·- k 2.q $-
3 It (L \- z_{i.q·)~ Ho
ETIDCS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.:. Article XIII, and the training requirement can be found on the web at: http://www.paimbeachcmJ1ntyethics.com/training.htm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _January 21, 2016 By attending a live presentation given on _______ , 20 __
By signing below I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of Florida ~?,.9£ o'Ethics: p1
/ ' ('I 11 j \ ( ' t *Applicant's Signatun{ f ·'\./ fa t,U Z/ Printed Name: J Ii( l~.11---,la.1 ~ 1\ Date: c9. \ I Co \ ! 0-")
· \..,.__ t/,,_./J \./ " I
Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section ID (Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
EDUCATION
VICKI A. Tucci, ESQUIRE 3781 ISLAND CLUB CIRCLE E, LANTANA, FLORIDA 33462
(561) 827-6263/[email protected]
NOVA SOUTHEASTERN UNIVERSITY, JURIS DOCTOR, CUM LAUDE, TOP I 0%, 2004 FLORIDA ATLANTIC UNIVERSITY, Bachelor of Political Science, CUM LA.UDE, 2001 SOUTH UNIVERSITY, Associate of Science in Paralegal Studies, MAGNA. CUM LA UDE, 1997
HONORS EDUCATION MANAGEMENT CORPORATION, Subject Matter Expert (Administrative & Constitutwna[ Law) ILSA JOURNAL OF INTERNATIONAL & COMPARATIVE LAW' Executive Editor ALLIANCE DEFENSE FUND, Blackstone Fellow, 2002 HONORABLE KENNETHL. RYSKAMP, U.S. DISTRICT COURT, S.D., Judicial intern FLORIDA BAR FELLOWSHIP RECIPIENT, PROB ONO HONORSPROGRA.M PARTICIPANT
COMMUNITY INYOLVEl\IENT PALM BEACH COUNTY HIV CARE COUNCIL, Member 08/2011-present PALM BEACH COUNTY COMMUNITY ALLIANCE COMMITTEE, Member 12/2009-present SOUTH UNIVERSITY ADVISORY BOARD, Member 1997-2010
EXPERIENCE LEGAL Am SOCIETY OF p ALM BEACH COUNTY, INC., West Palm Beach, Florida Staff Attorney, 12/05-06/07; 05/10-present
• Currently provide assistance to terminally ill clientele in an effort to provide them access to health care. Areas include: Social Security appeals, health insurance access, landlord/tenant and child support.
• Family law practice, included support, custody, dissolution of marriage and paternity actions • RecoYered over $2 million dollars in disaster funds for local non-profit organizations • Mediation of contracts with an emphasis on restoring wholeness to clientele • Resolved construction litigation claims and family matters through mediation and trials • Participated in court pandemic committee meetings, under the direction of the Chief Judge • Provided non-profit agencies assistance with insurance contract reviews and coverage, lease reviews and
recommendations, and disaster planning assistance, including plan reviews, contract development, revisions and trainings
• Participated in and conducted countywide employment trainings for non-profit agencies in the areas of Americans with Disabilities Act, Fair Labor Standards Act, employee classifications, wage & hour and general hwnan resource regulations and risk management
• Conducted county-wide disaster preparedness & recovery seminars for non-profit organizations
STATE OF FLO.RID A GUARDIAN AD LITEM PROGRAM, West Palm Beach, Florida Circuit Director, 06/07-05/10; CU/Staff Attorney, 09/03-07/05
• Oversight of recruitment, training, retention and management of hundreds volunteer GALs • Deyelopment of Program-procedures/policies -including first local human resource policy manual • Work along with the State GAL Program on human resources, financial and legal management o Responsible for all hiring, management, discipline and termination of staff o Review and advisement on proposed and upcoming legislation • Continuous risk management with a focus on the protection of the children and agency • Management of complaints, including investigation and final decision-making • Legal representation of the GAL Program and best interests of children in dependency court, including
representation at dependency and termination of parental rights trials
• Case management and oversight of internal case reviews and review processes • Collaboration with community child advocacy and legal organizations, including drafting and
development of Memorandum ofUnderstan<;ling and various contracts • Participation in management level case staffing meetings with agency partner leadership • Participation in numerous committees and boards, with a focus on the dependency system • Conduct presentations and trainings across the community on child advocacy and legal matters • Development of a supporting non-profit organiz.ation, including research and preliminary drafting of
corporation documents, selection and appointment of initial Board of Directors, legal advisement to the Board and continual oversight in all organization matters
• Brainstonned appellate strategies and drafted various appellate documents
SOUTH UNIVERSITY, West Palm Beach, Florida University & On-line Instructor, ABA-Approved Paralegal Program, 10/04-Present
Instruct paralegal students in the areas of: administrative law, computers in the legal office, constitutional law, contracts, domestic law, employment law, medical ethics/law, and probate
• Teach oral argument, public speaking, drafting and negotiation skills • Facilitate and supervise internships with graduating paralegal students • Provide input on program development and policies • Consultation and development of new online course materials, including Social Security Administration
Appeal projects and mock trials
AMERICAN COLLEGE OF PEDIATRICIANS, Nationwide organization, local office Lantana, Florida Executive Director, 06/05-03/07
• Worked along with a 15 member Board to develop and grow a young, nationwide, non-profit organization with a mission to assist children nationwide Ascertained the needs of the organization and moved forward in planning, recruitment, membership retention, and fundraising
• Wholly responsible for the day-to-day office management, including fiscal and budgeting • Provided legal advisement to the Board of Directors as the sole legal representative • Provided legal representation through a Amicus Curie brief filed with the U.S. Supreme Court • Researched and reviewed upcoming legislation and current laws nationwide Supervision and direction
of an independent contractor and volunteers
PRIVATE PRACTICE, SOLO PRACTITIONER, Palm Beach & Broward Counties, 07 /05-12/06 • Representation of clients in general practice areas, including: adoption, contracts, criminal, dependency,
employment, estates and probate, family, juvenile, and traffic matters • Co-counseled several Amicus Briefs to the United States Supreme Court • Provided contract services to other firms as needed
ALLIANCE DEFENSE FUND, Scottsdale, Arizona Blackstone Fellowship Intern, 06/02-08/02
• Trained on constitutional law, public policy, legal history and the philosophy oflaw • Conducted research and writing on complex constitutional issues • Provided strategy recommendations on large impact cases • Prepared press releases, radio clips, media responses, and memoranda
Brainstormed with attorneys from across the country on constitutional matters and strategies • Trained high school children in drafting and debating legislation
2
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department}: (Please Print)
Board Name: _P_alm_B_ea_c_h_C_o_u_n~ty~H_IV_C_ARE __ C_o_un_c1_·1 __________ Advisory [ x ) Not Advisory [
[ x ] At Large Appointment or l [ ] District Appointment /District #: __ _ 4.q,0 Ho 4-\rSl(C,
Term of Appointment: Years. -----3 From: April2016 To: _A_pr_il_2_0_1_9 ______ _
Seat Requirement: PBC Health Department-Local Public Health Agency Seat#: 11
[ x ] *Reappointment or [ ] New Appointment
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _ none __ _
Section II {Applicant}: (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: Kannel Last
Occupation/ Affiliation:
Business Name:
Business Address:
City & State
Residence Address:
Mary First
Operations and Management Consultant Manager
Owner [ ] Employee [ x ]
Florida Department of Health
1150 45th Street
_W_e_s_t P_a_lm_B_ea_c_h_, F_L __________ Zip Code:
4661 120 Ave North
_W_e_s_t P_a_lm_B_ea_c_h-'--, F_L __________ Zip Code:
Piper Middle
Officer [ ]
33407
33411 City & State
Home Phone: _(~-'-) ___________ Business Phone: (561) 514-5322
Cell Phone: _(.,__-'-) _________ Fax: ( )
Email Address: [email protected]
Mailing Address Preference: [ x ] Business [ ] Residence
Have you ever been convicted of a felony: Yes___ No _x __
Ext.
If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ ] Male [x ] Female [ ] Hispanic-American [ ] Asian-American [ ] African-AJ?erican [ x] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: (R#XX-XX/PO XX)
Bcl.DlS ~ 0107
NONE
Department/Division
Parks & Recreation
C DN\fV'W"-:+y ,\Pi ,11 tc.S
Description of Services
General Maintenance
(Attach Additional Sheet(s), if necessary) OR
D NOT APPLICABLE/ D (Governmental Entity)
10/01/00-09/30/2100
3 li l ,s ---~I 2-g l~o{~
ETIDCS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.,_ Article XIIl, and the training requirement can be found on the web at: http://www.palmbeachcmmtyethics.com/trainirng.Mm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article Xlll, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _January 25, 2016 By attending a live presentation given on _______ ., 20 __
By signing below I acknowledg_!..!ltat I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of F~qr-i a de ofJ-t1iics: /,,,. jJ ,
* Applicant's Signature· ;J ..........____ CJ'./ Prutlted Name: {Y] A-i1_j l<-9 /VIVV---, Date: o+jrr/tP Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III (Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
Mary Piper Kannel
Education
Antioch College
Ithaca College
Work Experience
Master's Program
Bachelor's Program
Clinical Psychology
No thesis & non-degreed
Psychology
Florida Department of Health, Palm Beach County, FL
Operations and Management Consultant
Haitian Center for Family Services, Riviera Beach, FL
Case Management Consultant
Comprehensive AIDS Program of Palm Beach County, Inc.
Case Manager, Client Services Coordinator, Director of Client Services
Island Princess Hotel, Turks and Caicos, BWI
Owner/Operator
Shakespeare Institute, Mahmoud Abad, Iran
Teacher
1975-1977
1975
2003-Present
2002-2003
1989-2002
1977-1989
1977
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department): (Please Print)
Board Name: _P_alm __ B_e_ac_h_C_o_un------'ty"--HIV __ C_A_RE __ C_o_un_c1_·1__________ Advisory [ x ] Not Advisory [
[ x ] At Large Appointment or 11
, 1 [ ] District Appointment /District #: __ _ -r, I/pf llp ~/ JS/ t°J
Term of Appointment: 3 Years. From: April2016 To: _A~p_ri_l2_0_1_9 ______ _
Seat Requirement: _A_ffi_e_ct_e_d_C_o_mm __ un_i_.ty'-R ____ ep..__r_e_se_n_ta_t1_·v_e __________ Seat#: 12
[ x ] *Reappointment or [ ] New Appointment
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _none __ _
Section IHApplicant): (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: _R_eyn"--o_l_ds ___________ M_ary--"--J_a_ne ______________________ _ Last First Middle
Occupation/Affiliation: _C_omm __ u_n_ity__,,__M_em_b_er ___________________________ _
Business Name:
Business Address:
City & State
Residence Address:
City & State
Home Phone:
Cell Phone:
Email Address:
Owner [ ]
Not applicable
Employee [ ]
_________________ Zip Code:
1665 NW 11th Street
_B_el_le_G_la_d---=e,'-F_L ___________ Zip Code:
__,_( 5_6_1..,_)_9_85_-_8_98_9 _______ Business Phone: ( )
_(..,__-'--) _________ Fax: ( )
Mailing Address Preference: [ ] Business [ x ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __
Officer [ ]
33430
Ext.
If Yes, state the court, nature of off ens~, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
. Page 1 of2
[ ] Male [x ] Female [ ] Hispanic-American [ ] Asian-American [ x] African-American [ ] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: <R#XX-XX/PO XX)
NONE
Department/Division
Parks & Recreation
Description of Services
General Maintenance
(Attach Additional Sheet(s), if necessary) OR
NOT APPLICABLE/ D ( Governmental Entity)
10/01/00-09/30/2100
ETIDCS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.,_ Article XIII, and the training requirement can be found on the web at: http://www.paimbeachcomrntyethics.com/traililling.htm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _January 21, 2016 By attending a live presentation given on _______ , 20 __
By signing below I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of Florida Code of Ethics:
*Applicant's Signature¾' fµJL Printed Name: =O'Lafi t ~N)Ut. Date: l I I,; j? .. 01; Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III {Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
Mary Jane Reynolds is from the Belle Glade, FL and has been a member of the Palm Beach
County HIV CARE Council for approximately 23 years. She currently serves as the chair of the
Community Awareness Committee and has been active in many other committees such as the
Planning committee and Priorities and Allocations committee. She is determined to continue
her active membership with the CARE Council and the Community Awareness Committee
because she has a passion for getting out into the community and educating others, as well as
navigating others through the process of receiving and staying in care. In addition to the CARE
Council, she is requested on a regular basis to speak about HIV/ AIDS at various local events. At
these events, she always promotes the importance of the CARE Council and ways to become
involved.
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none'' or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department}: (Please Print)
Board Name: _P_alm_B_ea_c_h_C_o_u_nty_.:__HI_V_C_A_RE_C_o_u_n_c_il __________ Advisory [ x ] Not Advisory [
[ x ] At Large Appointment or r I [ ] District Appointment /District #: '-lz fro/ J(p ll( 1~ /1 q
Term of Appointment: Years. -----3 From: April2016 To: _A..._pr_il_2_0_1_9 ______ _
Seat Requirement: _A_ffi_e_ct_e_d_C_o_mm __ un_i____,ty,__R_ep._r_e_se_n_ta_t_iv_e__________ Seat #: 14
[ x ] *Reappointment or [ ] New Appointment
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] . other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _ none __ _
Section II (Applicant}: (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESmENT
Name: Krabec Glenn Last
Occupation/ Affiliation:
Business Name:
Business Address:
City & State
Residence Address:
City & State
Home Phone:
Cell Phone:
Email Address:
Community Member
Owner [
Retired
First
Employee [ ]
_________________ Zip Code:
5754 River Club Circle
_Ju_._p_it_e""""r,_F_L _____________ Zip Code:
_(_,_5_6_1_,_) _22_2_-5_3_2_4 ______ Business Phone: ( )
_(,_____.)'--------- Fax: ( )
Mailing Address Preference: [ ] Business [ x ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __
Middle
Officer [ ]
33458
Ext.
If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ x] Male [ ] Hispanic-American
[ ] Female [ ] Asian-American [ ] African-American [ x] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's · board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code. ·
Contract/Transaction No.
Example: (R#XX-XX/PO XX)
NONE
Department/Division
Parks & Recreation
Description of Services
General Maintenance
(Attach Additional Sheet(s), if necessary) OR
NOT APPLICABLE/ D (Governmental Entity)
10/0l/00-09/30/2100
ETHICS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.!. Article XIII, and the training requirement can be found on the web at: http://www.palmbeachcmmtyethics.com/trnining.htm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _January 21, 2016 By attending a live presentation given on _______ , 20 __
By signing below I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of Florida Code of Ethics:
* Applicant's Signatur~ .~rinted NamuA __ e,_h~vt _ ____,;-!,___Y'._O--__ /_e_c: Date: A/! 1 /J Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III {Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
Glenn Krabec has been a member of the CARE Council for many years. He has been a leader both in title
and in CARE Couf')cil commitment. Glenn is currently the Vice-Chair of the Priorities and Allocations
committee and serves on the Membership Committee. He conducts the Robert's Rules of Order
trainings for all new members and serves as the expert for questions during meeting on protocol. Glenn
provides constructive feedback and thoughtful input during each CARE Council meeting. He thinks
through each issue and truly understands the balance between medical and support services issues. He
is an asset to the council and is excited to remain engaged as a member.
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department): (Please Print)
Board Name: _P_alm_B_e_a_c_h_C_o_un_ty~H_IV __ C_ARE __ C_o_u_n_c_il __________ Advisory [ x ] Not Advisory [
or [ x ] At Large Appointment
Term of Appointment: 3 Years. From: I
[ ] District Appointment /District #: 4 ,~, /<, 4{ ,r{J 9
April2016 To: _A_p_r_il_2_0_19 ______ _
Seat Requirement: Affected Community Representative Seat#: 16
[ x ] *Reappointment or [ ] New Appointment
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _ none __ _
Section II (Applicant): (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: Smith Last
Occupation/ Affiliation:
Business Name:
Business Address:
Community Member
Owner [ ]
Not applicable
Cecil First
Employee [ ]
City & State _________________ Zip Code:
Residence Address: 1500 North Congress Avenue #A-305
City & State
Home Phone:
_W_e_st_P_a_lm_B_e_a_ch_.;.,_F_L _________ Zip Code:
_(_,_5_6_1--<-) _4_60_-_4_10_2 _______ Business Phone: ( )
Cell Phone: _("----'-) _________ Fax: ( )
Email Address:
Mailing Address Preference: [ ] Business [ x ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __
Middle
Officer [ ]
33401
Ext.
If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ x] Male [ ] Hispanic-American
[ ] Female [ ] Asian-American [ x] African-American [ ] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: (R#XX:-XX/PO XX)
NONE
Department/Division
Parks & Recreation
Description of Services
General Maintenance
(Attach Additional Sheet(s), if necessary) OR
NOT APPLICABLE/ D (Governmental Entity)
10/01/00-09/30/2100
ETHICS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment!. Article XID, and the training requirement can be found on the web at: http://www.paimbeachcmJtJ01tyethics.com/tJraindng.Mm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _January 25, 2016 By attending a live presentation given on _______ , 20 __
By signing beJow I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of Florida Code of Ethics: ? 2 7 _L....,
* Applicant's Signature: ~;__,~d Name: Ct c., ~ \ 6 m ~¼Date: ;tlf. S-/fif,< / Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III {Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
I, Cecil Smith, have been a member of the Palm Beach County HIV CARE Council for over 13
years. I have enjoyed being a part of an organization that is important to the lives of HIV
positive men, women, and children. I have been a member of various committees such as
planning, community awareness, and joint medical and support services. Being a member, I am
in a position to help make decisions related to Ryan White programs. I want to always volunteer
and help others. Hopefully, I am a PWLHA that will make a difference and have an impact in the
HIV community. I am an advocate for people living with HIV and would like to continue to
make a difference.
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department): (Please Print)
Board Name: _P_alm __ B_e_ac_h_C_o_un_ty"--HI_V_C_A_RE __ C_o_u_n_c_il__________ Advisory [ x ] Not Advisory [
[ x ] At Large Appointment or
Term of Appointment: Years. 3 From:
4/Jf# J }(.} District Appointment /DIBt;J_/ il-f f Cj April2616 To: _A~p_ri_l2_0_1_9 ______ _ -----
Seat Requirement: _A_ffi_e_ct_e_d_C_o_mm __ un_i_.ty,_R__.ep.__r_e_se_n_ta_ti_·v_e __________ Seat#: 19
[ x ] *Reappointment or [ ] New Appointment
or [ ] to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _ none __ _
Section II (Applicant): (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: Samples Last
Occupation/ Affiliation:
Business Name:
Business Address:
Community Member
Owner [ ]
Not applicable
Shirley First
Employee [ ]
City & State _________________ Zip Code:
Residence Address: 1316 SW "B" Place Apt 1
City & State
Home Phone:
_B_el_le_G_la_d--'e,'-F_L ___________ Zip Code:
__,__( 5_6_1...<-)_5_98_-_12_1_1 _______ Business Phone: ( )
Cell Phone: _("'---"'--) _________ Fax: ( )
Email Address:
Mailing Address :ereference: [ ] Business [ x ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __
Ann Middle
Officer [ ]
33430
Ext.
If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ ] Male [x ] Female [ ] Hispanic-American [ ] Asian-American [ x] African-American [ ] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: (R#XX-XX/PO XX}
Department/Division
Parks & Recreation
Description of Services
General Maintenance 10/01/00-09/30/2100
NONE
(Attach Additional Sheet(s ), if necessary) OR
NOT APPLICABLE/ D (Governmental Entity)
ETHICS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.,_ Article XIII, and the training requirement can be found on the web at: http://www.palmbeachcomrntyethics.com/tranning.htm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
_x_ By watching the training program on the Web, DVD or VHS on _January 21, 2016 By attending a live presentation given on ______ _,, 20 __
By signing below I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment
& State of Florida C~effJfth"~: , ..J'
* Applicant's Signature: / ~ 4~ted Name: Sh/ k.J/ c54-"'1,,,, / ;;;_e: ,7; -/ C- / Ce
Any questions and/or concerns regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III {Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
Shirley Samples has been a member of the Palm Beach County HIV CARE Council for
approximately 21 years. She is a native of Belle Glade, FL and has become an engaged
community member and CARE Council member. Shirley represents her community and keeps
the needs of people with living with HIV at the forefront of her involvement. She enjoys being a
CARE Council member because she is able to learn more about local services and providers, as
well as positively impact her community. She has remained an active member of almost all of
the CARE Council committees for many years. She would like to remain a CARE Council member
to continue to be an asset to her community.
PALM BEACH COUNTY BOARD OF COUNTY COMMISSIONERS BOARDS/COMMITTEES APPLICATION
The information provided on this form will be used in considering your nomination. Please COMPLETE SECTION II IN FULL. Answer "none" or "not applicable" where appropriate. Please attach a biography or resume to this form.
Section I (Department): (Please Print)
Board Name: _P_alm __ B_ea_c_h_C_o_u_n____,ty"----HI_V_C_A_RE __ C_o_u_n_c1_·1___________ Advisory [ x ] Not Advisory [
[ x ] At Large Appointment or ] District Appointment /District#: __ _
Tenn of Appointment: ___ 3 ___ Years. From: April 16, 2016 To: April 15,2019
Seat Requirement: _P_art_D_:_S_e_rv_in_,g"'----C_h_il_dr_e_n,__, Y_ou_t_h,_, F_a_m_1_·1i_e_s _of_H_IV _______ Seat#: 31
[ x ] *Reappointment or [ ] New Appointment
or to complete the term of ___________ Due to: [ ] resignation [ ] other
Completion of term to expire on:
*When a person is being considered for reappointment, the number of previous disclosed voting conflicts during the previous term shall be considered by the Board of County Commissioners: _ none __ _
Section II (Applicant): (Please Print) APPLICANT, UNLESS EXEMPTED, MUST BE A COUNTY RESIDENT
Name: Tomici Last
Occupation/ Affiliation:
Jeannette First
TOPW A Supervisor
Middle
Owner [ ] Employee [ x ] Officer [ ]
Business Name:
Business Address:
City & State
Residence Address:
City & State
Home Phone:
Cell Phone:
Email Address:
Families First of Palm Beach County
3333 Forest Hill Blvd
_W_e_s_t _P_alm_B_ea_c_h-'--, _FL __________ Zip Code: 33406
1237 Pine Sage Circle
_W_e_st_P_a_hn_B_e_a_ch~,_F_L _________ Zip Code: 33409
~( ~) ___________ .Business Phone: ( 561) 721-2887
_(.;a._-"--) _________ Fax: ( 561) 721-2809
Mailing Address Preference: [ x ] Business [ ] Residence
Have you ever been convicted of a felony: Yes ___ No _x __
Ext.
If Yes, state the court, nature of offense, disposition of case and date: _____________________ _
Minority Identification Code: [ ] Native-American
Page 1 of2
[ ] Male [ x] Female [ x ] Hispanic-American [ ] Asian-American [ ] African-American [ ] Caucasian
Section II Continued:
CONTRACTUAL RELATIONSHIPS: Pursuant to Article XIII, Sec. 2-443 of the Palm Beach County Code of Ethics, advisory board members are prohibited from entering into any contract or other transaction for goods or services with Palm Beach County. Exceptions to this prohibition include awards made under sealed competitive bids, certain emergency and sole source purchases, and transactions that do not exceed $500 per year in aggregate. These exemptions are described in the Code. This prohibition does not apply when the advisory board member's board provides no regulation, oversight, management, or policy-setting recommendations regarding the subject contract or transaction and the contract or transaction is disclosed at a public meeting of the Board of County Commissioners. To determine compliance with this provision, it is necessary that you, as a board member applicant, identify all contractual relationships between Palm Beach County government and you as an individual, directly or indirectly, or your employer or business. This information should be provided in the space below. If there are no contracts or transactions to report, please verify that none exist. Staff will review this information and determine if you are eligible to serve or if you may be eligible for an exception or waiver pursuant to the code.
Contract/Transaction No.
Example: (R#XX-XX/PO XX)
NONE
Department/Division
Parks & Recreation
Comm u b, ~ \1 nJ,1'$/ FM~
Description of Services
General Maintenance
(Attach Additional Sheet(s ), if necessary) OR
D NOT APPLICABLE/ D ( Governmental Entity)
10/01/00-09/30/2100
1 o/o, /1 s-- - 01-{-30/,ep r •
ETHICS TRAINING: All board members are required to read and complete training on Article XIII, the Palm Beach County Code of Ethics, and read the State Guide to the Sunshine Amendment.,_ Article XIII, and the training requirement can be found on the web at: http://www.pa[mbeachcmrntyethics.com/training.htm. Ethics training is on-going, and pursuant to PPM CW-P-79 is required before appointment, and upon reappointment.
By signing below I acknowledge that I have read, understand, and agree to abide by Article XIII, the Palm Beach County Code of Ethics, and I have received the required Ethics training (in the manner checked below):
x By watching the training program on the Web, DVD or VHS on _February 15, 2016 By attending a live presentation given on------~ 20 __
By signing below I acknowledge that I have read, understand and agree to abide by the Guide to the Sunshine Amendment & State of Florida Ethics:
* Applicant's Signature:----"s:~~1-;,"------- Printed Name: JQ,o Y\(\ tltf \ (j/11',' ~~: a I !(.Q ~ (o Any questions and/or conce regarding Article XIII, the Palm Beach County Code of Ethics, please visit the Commission on Ethics website www.palmbeachcountyethics.com or contact us via email at [email protected] or (561) 355-1915.
Return this FORM to: {Insert Liaison Name Here}, {Insert Department/Division Here}
{Insert Address Here)
Section III (Commissioner, if applicable): Appointment to be made at BCC Meeting on:
Commissioner's Signature: _________________ Date: ____________ _
Pursuant to Florida's Public Records Law, this document may be reviewed and photocopied by members of the public. Revised 02/01/2016
Page 2 of2
Areas of Specialty
Education
Relevant
Jeannette Tomici 1237 Pine Sage Circle West Palm Beach, FL 33409- 561.351.8810- [email protected]
HIV/AIDS Pregnant Women
• Sexual, Physical & Emotional Abuse • Child & Family Welfare
Master of Social Work Barry University- Palm Beach Gardens, FL
Bachelor of Social Work Florida Atlantic University- Boca Raton, FL
• Bilingual; Fluent in Spanish & English • Domestic Violence • Substance Abuse
August, 2012- December, 2013
August, 2007 - December, 2011
Experience Healthy Families TOPW A and Oasis Program Supervisor April 2014- Present
• Directing, planning and supervising staff. • Planning events for program and agency. • Evaluating performance of staff and reflecting upon opportunities and positive traits. • Data collection. • Networking and outreach activities with other community providers. • Engagement in collaborative services. • Evaluation of program outcomes. • Preparation of program reports. • Staffing HIV infected cases. • Attend CPP and Care Council Meetings.
Healthy Families January, 2012-April 2014 Family Support Worker
• Cultivating and strengthening nurturing parent-child relationships in a healthy, safe home.
• Providing education about the importance of child health, immunizations and well-baby check-ups.
• Conducting child screenings for developmental delays which promote healthy childhood growth and development.
• Promoting self-sufficiency by setting and achieving goals, furthering their education and acquiring stable employment.
• Facilitate monthly support groups.
• Record and manage case notes.
SOCIAL WORK INTERNSHIP (Masters) Partners for Change
January 2013-August, 2013
• Provide therapeutic intervention services to adult substance abusers. Facilitated six adult groups in cases of substance abuse with focus on treatment plan goals and objectives.
• Conduct bio psychosocial on participants. • Provide emergency crisis counseling. • Prepare and demonstrate safety-plans.
Qne-on-one therapy. Maintain updated accurate clinical files in compliance with state and federal regulations.
• Participate in clinical roundtable.
Community Service Activities
Professional References
SOCIAL WORK INTERNSHIP (Bachelors) August, 2010- May, 2011 The Children's Place at Home Safe
Tomici, Jeannette
• Provide therapeutic intervention services to children and adolescents using individual, family, and group treatment.
• Co-facilitate children and adolescent groups in cases of domestic violence with focus on treatment plan goals and objectives.
• Complete case management notes on a daily basis as needed for non-clinical interventions. • Conduct bio psychosocial on children and adolescents. • Provide emergency crisis counseling to victims of domestic violence. • Facilitate parenting classes for female victims with a focus on managing difficult behavior and
encouraging good behavior in children; classes are followed up by processing. • Prepare and demonstrate safety-plans with children and adolescents. • Maintain updated accurate clinical files in compliance with state and federal regulations. • Participate in clinical roundtable. • Administrative duties including, but not limited to filing, organizing, computer input, research.
• Community Prevention Partnership (CPP)
• Palm Beach County HIV/ AIDS Care Council member
• National Association of Social Work (NASW) member
• Yearly volunteer assistant-coordinator for The Clarence Clemons Classic to benefit Home Safe
• Maria Cabrera, LCSW HCHV Homeless Coordinator 561.667.5203 - Mobile Healthcare for Homeless Veterans Program (Building 6) West Palm Beach V AMC/122 7305 North Military Trail West Palm Beach FL 33410
• Cristy Johnson, LCSW 561.313.3859 - Mobile Women's Wellness Clinic / VA West Palm Beach VAMC/122 7305 North Military Trail West Palm Beach FL 33410
• Joe Maltese Marketing Director 561. 722.5645 - Mobile Home Safe 2840 6th A venue South Lake Worth, FL 33461
Palm Beach County HIV CARE Council
Proposed Inventory of Seats Updated 2.17.16
Grey Shading= Federally Mandated Seat Pastel Shading= Federally Mandated Category Bold= OPEN CHAIR
Recently approved by BCC - renewal member
SEAT PROVIDERS - SEATS 1-11 OCCUPANT POSITION/ORGANIZATION TERM DEMOGRAPIDC
EXPIRES INFO.
1 Health care provider, including federally qualified health centers
OPEN CHAIR / ,-
Community-Based Organizations serving affected populations/ AIDS Service Legal AID Society of Palm Beach 2 Organizations Vicki Ann Kruse}
County, Inc. 4/15/2016 WF
Community-Based Organization serving affected populations/AIDS Service OPEN CHAIR 3 Organizations
Community-Based Organizations serving affected population/AIDS Service OPEN CHAIR 4 Organizations
'" /
FoundCare, Inc. 5 Social Service Providers, including housing and homeless service providers Quinton Drunes 09/21/2018 BM
6 Social Service Providers, including housing and homeless service providers Lilia Perez FoundCare, Inc. 10/06/2017 HF
Kimberly Rommel-Legal AID Society of Palm Beach 11/14/2016 7 Social Service Providers, including housing and homeless services providers Enright
County, Inc. WF
8 Social Service Providers, including housing and homeless service providers OPEN CHAIR '\
f 9 Mental Health and/or Substance Abuse Provider Jesus Bautista Compass, Inc. 9/21/2018 HM
l Thomas McKissack Jerome Golden Center for
BM 10 Substance Abuse and/or Mental Health Providers Behavioral Health 11/14/2016
11 Local Public Health Agencies Mary Piper Kannel PBC Health Department 4/15/2016
WF
Pal111 Beach County HIV CARE Council
Proposed Inventory of Seats
AFFECTED COMMUNITIES, INCLUDING PLWH AND IDSTORICALLY TERM DEMOGRAPIDC SEAT UNDER-SERVED SUBPOPULATIONS AND/OR INDIVIDUALS CO- OCCUPANT POSITION/ ORGANIZATION EXPIRES INFO. INFECTED WITH HEPATITIS B/C - SEATS 12 - 22
I 12 Affected Communities, including People Living with HIV/ AIDS and historically Community Member 4/15/2016 under-served subpopulations and/or individuals co-infected with Hepatitis B/C
Mary Jane Reynolds BF
13 Affected Communities, including People Living with HIV/AIDS and historically OPEN CHAIR Community Member under-served subpopulations and/or individuals co-infected with Hepatitis B/C
Affected Communities, including People Living with HIV/ AIDS and historically Glenn Krabec, PhD Community Member 4/15/2016 14 under-served subpopulations and/or individuals co-infected with Hepatitis B/C WM
Affected Communities, including People Living with HIV/AIDS and historically OPEN CHAIR 15 under-served subpopulations and/or individuals co-infected with Hepatitis B/C
16 Affected Communities, including People Living with HIV/ AIDS and historically Cecil Smith 4/15/2016 BM under-served subpopulations and/or individuals co-infected with Hepatitis B/C Community Member
Affected Communities, including People Living with HIV/AIDS and historically 17 under-served subpopulations and/or individuals co-infected with Hepatitis B/C OPEN CHAIR
Affected Communities, including People Living with HIV/AIDS and historically OPEN CHAIR
18 under-served subpopulations and/or individuals co-infected with Hepatitis B/C
19 Affected Communities, including People Living with HIV/AIDS and historically
Shirley Samples Community Member 4/15/2016 BF under-served subpopulations and/or individuals co-infected with Hepatitis B/C
20 Affected Communities, including People Living with HIV/ AIDS and historically Don Hilliard Community Member 11/14/2016 WM under-served subpopulations and/or individuals co-infected with Hepatitis B/C
21 Affected Communities, including People Living with HIV/AIDS and historically OPEN CHAIR under-served subpopulations and/or individuals co-infected with Hepatitis B/C
22 Affected Communities, including People Living with HIV/AIDS and historically OPEN CHAIR under-served subpopulations and/or individuals co-infected with Hepatitis B/C
2
-I
\_
Palm Beach County HIV CARE Council
Proposed Inventory of Seats
TERM DEMOGRAPIDC SEAT NON-ELECTED COMMUNITY LEADERS - SEATS 23 - 33 OCCUPANT POSITION/ORGANIZATION EXPIRES INFO.
23 Non-Elected Community Leaders OPEN CHAIR
24 Non-Elected Community Leaders Chris Dowden Skyemed 9/21/2018 WM
25 Non-Elected Community Leaders Denise St. Joy Nursing Services of Palm Beach 10/06/2017 CF
26 Non-Elected Community Leaders OPEN CHAIR
27 Non-Elected Community Leaders OPEN CHAIR
OPEN CHAIR 28 State Medicaid Agency
29 State Part B Agency Mitchell Durant Florida Health, Palm Beach County 11/14/2016 WM
30 Hospital Planning Agencies or other health care planning agencies OPEN CHAIR
31 Part D, or if none present, representatives of organizations addressing the needs of Jeannette Tomici Families First of Palm Beach County 04/15/2016 HF
children, youth, and families with HIV
32 Other federal HIV Programs, including HIV Prevention Program Patrice Huntley Compass, Inc. 01/25/2019 BF
33 Representative of/or formerly incarcerated People Living with HIV/AIDS Stephanie Jordan Community Member 04/15/2019 BF
Demographic Info Key: BF= Black Female, BM= Black Male, HAIF= Haitian Female, HAIM= Haitian Male, WF= White Female, WM= White Male, HISF= Hispanic Female, HISM= Hispanic Male, M= Multi-Race
3
Palm Beach County HIV CARE Council
CARE Council Policy Policy Number: Approved: Amended: Amended: Amended: Amended: Amended:
Issue:
10 April 30, 2001 January 26, 2004 November 16, 2009 November 22, 2010 June 27, 2011 June 25, 2012
Nominations Process for CARE Council Membership
This policy is adopted by the CARE Council (CARE Council), for the purpose of ensuring there is an open and fair nomination process which will provide for a CARE Council membership which is reflective of the Al OS epidemic in Palm Beach County, Florida. In addition, it is the intention of the CARE Council to maintain a nomination policy which complies with directives of the Division of HIV Services (OHS) and HRSA as those directives relate to the Ryan White Act.
I. Legislative Background
Section 2602(b) of the reauthorized Ryan White Act states: "Nominations to the planning council (CARE Council) shall be identified through an open process and candidates shall be selected based upon locally delineated and published criteria. Such criteria shall include a conflict of interest standard for each nominee."
II. Expectations
An open nominations process, in combination with other legislative requirements and existing OHS policy on PLWH participation, shall result in broad and diverse community inclusion and culturally competent deliberations in CARE Council processes. The CARE Council will only approve and/or appoint members who have gone through the nominations process and shall appoint members on a timely basis to ensure minimum disruption to CARE Council activities.
Nominations to the CARE Council shall be sought from a wide spectrum of potential members. Recruitment shall be made through existing CARE Council committees and
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through ongoing solicitation through existing CARE Council members, service providers, outreach through advertising, and staff working with consumers of HIV/AIDS services. Particular consideration shall be given to disproportionately affected and historically underserved groups and sub-populations.
Every member of the CARE Council is encouraged to actively recruit members to fill gaps in CARE Council membership. Recruitment is not just the Membership Committee's responsibility. CARE Council members should use their own network and seek key contacts in other communities to help identify potential members to fill gaps and to provide individuals to participate in CARE Council committee activities.
Ill. Steps in the Nominations Process:
1. When necessary advertising may be placed in various publications countywide notifying the public of the need for participation through membership on the CARE Council. Included in the advertising shall be notification of the need to fill membership positions based upon the demographics of the epidemic in Palm Beach County, and to ensure legislatively mandated positions are filled. A time limit for return of applications shall be included in the notification.
2. Potential_ applicants shall be provided a nominations packet containing a letter describing roles and responsibilities of the CARE Council, duties of membership, time expectations, gaps in representations, conflict of interest standards, HIV disclosure requirements, and an overview of the selection process and timeline; within three (3) business days of request. There shall also be an application form used to gather information about: relevant experience, expertise, skills, the person's interest in serving, the perspective he or she might bring to the CARE Council, how his or her peer group might relate to groups affected by HIV, and other related information.
3. Each returned application will be issued a document number, and receipt shall be logged in for tracking purposes.
4. CARE Council staff will review all application forms and will recommend a list of persons for the Membership Committee to interview per "Procedure for Applicant Interviews". When two or more persons apply for the same slot, the committee will interview at least two applicants for the slot. Interviews shall be conducted by at least two committee members-one of which must be the Chair or Vice Chair and a staff member, according to a structured interview format. Open ended • questions about past experience on boards, ideas about significant HIV/AIDS issues and professional or affected community linkages shall be incorporated into the interview.
5. After the interviews are completed, the results of each interview are discussed at the next regularly scheduled Membership Committee meeting. When reviewing
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candidates for membership the committee will consider the following factors: attendance at CARE Council meetings, involvement at Membership Development Sessions and involvement on committees. The Membership Committee may also consider activities as involvement in Membership Development Sessions. In addition, seat availability, the demographics of the board and candidate qualification will be taken into consideration. The final committee recommendations will be forwarded to the Executive Committee and if approved to the CARE Council. If the recommendation is accepted by the CARE Council, the individual's name will then be forwarded to the Palm Beach County Board of County Commissioners for appointment. The candidate must document completion of the Palm Beach County ethics training prior to submission of their name to the Palm Beach County Board of County Commissioners. In the event a recommended candidate is not acceptable to the Palm Beach County Board of County Commissioners, a request for a replacement candidate, if available, will be forwarded to the Membership Committee and the Membership Committee will provide the name of another candidate to the CARE Council. If the recommendation is accepted by the CARE Council, the individuals name will then be forwarded to the Palm Beach County Board of County Commissioners for appointment.
1. candidates must fulfill the following requirements prior to being forwarded for CARE Council Membership; candidates must join one (1) committee and attend at least three (3) meetings. one (1) of which must be either a CARE Council meeting, or CARE Council sponsored training (inclusive of annual retreat) within a one (1) year period.
2. Documented exceptions to these requirements may be made, based upon the need of the CARE Council or in an extenuating circumstance, at the discretion of the Membership Committee Chair with the approval of the Executive Committee.
20 IP age
YES {Seat 15)
YES
YES
CARE COUNCIL MEMBERS ATTENDANCE COMPLIANCE TRACKING FORM -TALLIED January 2015 to December 2015
Palm Beach County HIV CARE Council Committee
{Seat 15)
YES
N/A
No Meeting
N/A
N/A N/A
YES YES
N/A
YES (Seat 15}
YES
N/A N/A
NEW MEMBER
N/A
No YES
N/A N/A
N/A N/A
YES N/A YES (Seat 15}
YES YES
No Meeting
N/A N/A N/A
N/A
N/A
No No Meeting Meeting
N/A
N/A
YES No No Meeting Meeting
YES No No Meeting
No No Meeting
N/A N/A
YES No No Meeting Meeting
YES YES YES No
N/A
No No
2015 Palm Beach County HIV CARE Council Attendance Tallied by sw
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N/A N/A N/A N/A N/A
YES
N/A
YES
YES
N/A
OPEN SEAT
N/A N/A N/A N/A
Removed
N/A N/A N/A
Meeting
2015 Palm Beach County HIV CARE Council Attendance Tallied by sw
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